Incremental benefit of preoperative EUS for the detection of pancreatic neuroendocrine tumors: a meta-analysis

James, Paul D.; Tsolakis, Apostolos V.; Zhang, Mei; Belletrutti, Paul J.; Mohamed, Rachid; Roberts, Derek J.; Heitman, Steven J.

doi:10.1016/j.gie.2014.12.031

Cited by 70 publications

(76 citation statements)

References 36 publications

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“…EUS is an additional imaging modality, and has additional benefits in preoperative diagnosis[24]. Somatostatin receptor imaging (SRI) is a functional imaging modality of choice in the evaluation of neuroendocrine tumors.…”

Section: Imagingmentioning

confidence: 99%

Non-functioning pancreatic neuroendocrine tumors: Surgery or observation?

Bar-Moshe

Mazeh

Grozinsky‐Glasberg

2017

WJGE

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Incidentally detected, sporadic, nonfunctional pancreatic neuroendocrine tumors are increasingly diagnosed on imaging studies performed for unrelated purposes. Although their resection is usually recommended, controversy still exists regarding their optimal management, due to their highly variable and difficult to predict biologic behavior. Recently, several studies and guidelines advocated an expectant management approach in small size, low grade, incidentally diagnosed nonfunctional pancreatic neuroendocrine tumors. The aim of this study is to review and summarize the available literature addressing nonfunctional pancreatic neuroendocrine tumors, with an emphasis on surgical management controversies.

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Section: Imagingmentioning

confidence: 99%

Non-functioning pancreatic neuroendocrine tumors: Surgery or observation?

Bar-Moshe

Mazeh

Grozinsky‐Glasberg

2017

WJGE

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“…For most patients, endoscopic ultrasound evaluation leads to less invasive and costly treatments. [13][14][15][16] Single-and multicentre studies have shown an increase in the application of endoscopic ultrasonography over time; 17,18 however, these findings may not be generalizable to broader populations. Furthermore, little is known about regional Regional differences in use of endoscopic ultrasonography in Ontario: a population-based retrospective cohort study trends in use.…”

mentioning

confidence: 99%

Regional differences in use of endoscopic ultrasonography in Ontario: a population-based retrospective cohort study

et al. 2017

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Background: Endoscopic ultrasonography is a safe and accurate modality for evaluating and managing hepatobiliary and gastrointestinal conditions (malignant and nonmalignant); its use is increasing. The aim of this study was to describe regional trends in the use of endoscopic ultrasonography in Ontario. Methods:We conducted a population-based retrospective cohort study using health administrative databases. We identified all patients who underwent an endoscopic ultrasound procedure in Ontario from 2003 to 2011 using physician billing data. Patient, physician and institution characteristics were examined. The primary outcome was use of endoscopic ultrasonography. Results:We identified 9076 endoscopic ultrasound procedures performed in 8001 patients (3858 women [48.2%]; median patient age at first procedure 59 years). A total of 3066 procedures (33.8%) involved fine-needle aspiration. Use of endoscopic ultrasonography increased 17-fold over the study period. In 2011, people living in the health region with the highest rate of use of endoscopic ultrasonography were more than 4 times more likely to undergo the procedure than people living in the health region with the lowest rate of use (standardized rate 61.6 v. 12.9 per 100 000). About 7 in 10 endoscopic ultrasound procedures were performed in an academic institution or regional cancer centre. All 17 endoscopists performing endoscopic ultrasonography during the study period practised in urban areas.Interpretation: Although the use of endoscopic ultrasonography increased over time in Ontario, there were marked regional differences in use. Provincial needs-and evidence-based initiatives may be needed to narrow the regional gaps in provision of endoscopic ultrasound services in the province. AbstractResearch Research CMAJ OPEN E438CMAJ OPEN, 5(2)

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“…[10] Two investigators (PDJ, ZWM) created an initial electronic bibliographic database search strategy, which was subsequently refined by a medical librarian with extensive systematic review experience. Unrestricted searches of MEDLINE and EMBASE were conducted from their first available date for studies reporting on the association between EUS, surgical decision-making and/or survival in patients with pancreatic adenocarcinoma (the inception search performed on January 18 th 2013; with updated searches were performed on December 18 th 2014, October 15 th 2015 and January 7 th 2017).…”

Section: Methodsmentioning

confidence: 99%

“…In situations where other modalities were also used, we determined the number of cases where unresectable disease was detected only by EUS. [10]…”

Section: Methodsmentioning

confidence: 99%

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The incremental benefit of EUS for identifying unresectable disease among adults with pancreatic adenocarcinoma: A meta-analysis

et al. 2017

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Background and study aimsIt is unclear to what extent EUS influences the surgical management of patients with pancreatic adenocarcinoma. This systematic review sought to determine if EUS evaluation improves the identification of unresectable disease among adults with pancreatic adenocarcinoma.Patients and methodsWe searched MEDLINE, EMBASE, bibliographies of included articles and conference proceedings for studies reporting original data regarding surgical management and/or survival among patients with pancreatic adenocarcinoma, from inception to January 7th 2017. Our main outcome was the incremental benefit of EUS for the identification of unresectable disease (IBEUS). The pooled IBEUS were calculated using random effects models. Heterogeneity was explored using stratified meta-analysis and meta-regression.ResultsAmong 4,903 citations identified, we included 8 cohort studies (study periods from 1992 to 2007) that examined the identification of unresectable disease (n = 795). Random effects meta-analysis suggested that EUS alone identified unresectable disease in 19% of patients (95% confidence interval [CI], 10–33%). Among those studies that considered portal or mesenteric vein invasion as potentially resectable, EUS alone was able to identify unresectable disease in 14% of patients (95% CI 8–24%) after a CT scan was performed.LimitationsThe majority of the included studies were retrospective.ConclusionsEUS evaluation is associated with increased identification of unresectable disease among adults with pancreatic adenocarcinoma.

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Incremental benefit of preoperative EUS for the detection of pancreatic neuroendocrine tumors: a meta-analysis

Cited by 70 publications

References 36 publications

Non-functioning pancreatic neuroendocrine tumors: Surgery or observation?

Non-functioning pancreatic neuroendocrine tumors: Surgery or observation?

Regional differences in use of endoscopic ultrasonography in Ontario: a population-based retrospective cohort study

The incremental benefit of EUS for identifying unresectable disease among adults with pancreatic adenocarcinoma: A meta-analysis

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